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Sunday, November 27, 2016

Sesamoid Injury Playlist


  1. Hi Dr. Blake! I discovered your blog today, and I am very grateful. I have a fibular sesamoid fracture- I have been in a removable walking boot for the past 7 months. I'm at a complete loss of what to do. I still feel pain, up to a 5 or 6 level. I generally have a high pain tolerance and a "get through with it-tough" attitude which is why I'm able to deal with it. But as you know, it's frustrating.

    What else can I be doing? Every doctor I go to (4+) seems like they don't know any answers and all they tell me is "just keep wearing the boot, maybe get surgery if you want to but the surgery doesn't go that well so maybe not". I also wear dancer pads. I have a bone stimulator, but honestly don't use it because half the doctors told me it doesn't help. I still bike and exercise arms, but I limit my walking. I'm normally a very active person with running (though nothing crazy long distances); I may have broken it after a skiing trip, but I honestly don't know. The pain just appeared last March, and my doctor didn't recommend an X Ray until June which is when I started wearing the boot. The pain has gone from a sharp direct pain, to an overall throbbing, though it's hard to tell sometimes if it would be sharp since I don't usually walk on it. But it still hurts even just sitting in the boot doing nothing, with a throbbing.

    I know you've answered this a thousand times before, but you seem to be the only one with expertise in this area. On another note, I got an MRI in August and they said there is no necrosis, aka as you know it *could* (but clearly isn't). I get x rays semi-regularly and there is still a large fracture, with two smaller fractures, my doctors like to use the words "blown apart" and "exploded" which I find unsettling to say the least. I just want to get back to normal life.

    More info- I'm a 22 year old female, normally very healthy and like I said I've always been active in a healthy way and eat well. I hadn't heard about potential calcium deficiencies until reading your posts, so if you have any specific products you think I should buy I'd greatly appreciate it.

    I currently live in the DC area- if you also happen to have any recommendations for a doctor/what kind of doctor to seek out. I appreciate any help, even small, that you might be able to offer as an insight.

    Thank you!

    1. Melissa, sorry for you problems. I would go to my friend Dr Stephen Pribut in DC, he is a wonderful caring podiatrist. You can send me images of the sesamoids from different angles to my email Yes, get your Vitamin D3 level taken, so you can rule that out. Our ballet dancers, known for sometimes strange eating habits, take 2 sugar free Tums each evening if they have not eaten over 500 mg calcium that day to supplement. Do you have a great orthotic to off weight the sesamoid? Are you icing each day? Definitely daily bone stimulation and contrast bathing is crucial for blood flow and bone strength. Have you tried the Hoka One One shoes with some dancer's pads? Rich
      I will look for your response in the next 2-3 days.

    2. Hi Dr. Blake!

      First off, I really appreciate your response- it means a lot to hear some real and caring expertise! I just submitted an appointment request via Dr. Pribut's website and I really look forward to meeting him as well, thank you!

      I'd be more than happy to send you my x-rays if you have a minute to look at them- I'll get them from my doctor today and send them on their way.

      I received custom-made orthotics about two months ago, and while I wear them I have not wholly seen a large difference, but will continue to do so. We have added some more arch support that perhaps I could re-tape to secure better results.

      I have not heard of contrast bathing at all- will absolutely try, thank you for the recommendation! Same goes for the Hoka One One shoes, I just researched them online and they look like they could be a good alternative to at the very least getting out of boot. Would you recommend that sort of transition?

      I think my main problem is that it's extremely difficult to limit my walking- I honestly don't walk that much as I have an office job, and I purposely take uber a lot, but it seems the most effective way of healing this is not doing anything to it and that is difficult as part of a normal life, as it still seems to hurt no matter if I limit my walking as much as I can. I really appreciate your advice on the active things I can be doing, such as the calcium, icing, and bone stim.

      Again, much appreciated!

  2. Hello! Hope it gets better. I don't know if Dr Blake will see this and reply, hopefully he does! But after combing through many of his posts, I can confidently say he'd recommend at least 9 months of bone stim. I don't use it because I don't have it here in SG, but since you do, why not use it?

    The longer bones are fractured the more chances of it getting to avascular necrosis so you want to avoid that as best as you can.

    As for the boot, I did think it was more painful to keep the boot on because your feet has to be in a certain way and sometimes that means you'll be pressing the foot right onto the metal plate trying to stretch (yikes). If it's possible and you don't have to go to many places, you can definitely take off the boot when lying on the bed or couch (but be careful!!), then you wanna basically buy all sorts of cushioning you can and don't mind cutting up and play shoe insole designer because you're going to create the best foot bed for your foot that will support the arches but be so comfy it literally is like having a baby cradle for your poor foot to sleep in when it needs to go out. Comfort > support until your feet is able to get stronger, then you can increase the amount of support.

    Do the ice baths, they should help with pain.

    It's definitely hard but you have to really dig out all the patience and wait an eternity without knowing if you are getting better because you basically won't be able to see for sure whether the bones are healing until months later. Even when you do get to the point where everything seems okay and painless, you HAVE to keep resting and taking it way slower than you would like it to, so the faster you can accept that and design new routines that you can commit to the better. It took me months to finally accept that I will have to change the way I exercise that relives pressure off my feet for at least 8 months before I can even think about doing anything remotely close to what I was doing before.

    For exercises I've pretty much resigned myself to pool when I can and Caroline Jordan has some amazing hurt foot pilates vids with super encouraging words to go along with it. I love her! She currently is suffering from sesamoiditis as well, so you can be sure the exercises she designs are totally for sesamoid problems in mind! If you find it useful, do send her love. I don't know her at all, but I can't describe how much her vids have been encouraging to me as with Dr Blake's posts and knowledge he shares.

    1. Faeleia, thank you so very much for your kind words and sharing. This is what this blog should be all about, and you are sooooo helpful. Thank you. I will definitely check out Caroline Jordan's videos also. Thank you. Rich

    2. Hi Faeleia!

      Thank you so much for your kind and heplful response, it was really thoughtful. I appreciate the advice on continuing to take things slower than I normally would, as it is hard to keep sight of that but the extra patience even after a long time clearly is necessary.

      I do tend to take the boot off while resting on a couch, so I'm glad that's alright. I didn't realize ice baths would also be helpful as I've typically only associated those with muscle injuries (though I suppose the bone affects the surrounding tendons) so I will try those as well with the bone stim!

      I look forward to trying the Caroline Jordan videos- I've resorted to only minimal biking and boxing and will gladly welcome some new exercises.

      Thank you so much for your help! It really means a lot to hear other people who have gotten through this!


Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.